Brewerytown RX Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP482063 Issued in PA

Legal business name

BREWERYTOWN RX INC

Practice address

2621 W Girard Ave
Philadelphia, PA 19130-1333

Phone

(267) 773-8349

NPI assigned

Dec 6, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Justice E.K. Hagan, PHARMD

Title

Pharmacy Manager

Phone

(267) 773-8349

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA2 enrollments

Enrollment records 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Abiola Abeeb, PHARMD

  • Pharmacist
  • Philadelphia, PA
  • NPI 1477176402
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1291593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1499299200000",
    "number": "1881997336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2621 W GIRARD AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191301333",
            "telephone_number": "267-773-8349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2621 W GIRARD AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191301333",
            "telephone_number": "267-773-8349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREWERYTOWN RX INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-06",
        "last_updated": "2017-07-06",
        "status": "A",
        "authorized_official_last_name": "HAGAN",
        "authorized_official_first_name": "JUSTICE",
        "authorized_official_middle_name": "E.K.",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "267-773-8349",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP482063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA PHARMACY PERMIT NUMBER",
            "identifier": "PP482063",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Matthew Brewer, DPT
• Gretchen Brewer, OD
• Maggie Brewer
• Richard J Brewer, MFT
• Sophia Brewer
• Carrie Brewster, FNP-BC
• Zachary William Brewster, DO
• Jennifer Sarah Brey
• Garrett Michael Breyer
• Joseph H Brezin, MD

• Community/Retail Pharmacy in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Community/Retail Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.